The report is available in English with a French summary - KCE

KCE reports 57 Musculoskeletal & Neurological Rehabilitation 163
8.4 FRANCE
8.4.1 Health care organisation in general hh
The French health care system is a centralised mixed system combining elements of
various organizational models:
8.4.1.1 Health insurance
• It is a publicly funded system characterized by freedom of choice and
unrestricted access for patients and freedom of practice for
professionals;
• The organizational model is built on health insurance funds and strong
state intervention. it is complex and pluralistic in its management, with
co-management by the state and the health insurance funds.
• It combines public and private health insurance, which finance the
same services by the same providers for the same populations;
• it combines public and private care, including private for-profit
hospitals;
The financial management of health care in France is mainly regulated through the
statutory health insurance as a branch of the wider social security. It covers the entire
population of France. The health insurance system, offers wide-ranging reimbursement
in the fields of preventive, curative, rehabilitative, and palliative care.
There are three main schemes within the statutory health insurance system: a general
(employees in commerce and industry and their families), an agricultural scheme for
farmers and their families and a scheme for self-employed people. In 2004 an insurance
fund was established specifically for dependent elderly people. In 1999 universal health
insurance coverage (CMU) was established on the basis of residence in France (99.9%
coverage for medical expenses).
The health insurance is compulsory and covers all households regardless of health
status, income, number of persons, etc. It provides a somewhat uniform field of
reimbursement, with the “basket of goods and services” covered by the insurance funds
being identical for all the statutory schemes, and a same reimbursement rate for the
three main insurance schemes (since 2000).
Health benefit catalogues are drawn up at national level with the whole range of goods
and services reimbursed by the statutory scheme. The reimbursement of goods and
services depends on their inclusion in defined lists, identified through advice of ad hoc
scientific commissions and agencies, such as the former National Agency for
Accreditation and Evaluation in Health Care (ANAES)- the current haute autorite de
santé (HAS), checking for the effectiveness and/or safety of these procedures and the
conditions under which they need to be per formed
More selection is occurring in the insured services delivered by private sector
profession in their own practices or in private for-profit hospitals. Services dispensed in
public hospitals or private not-for-profit hospitals are mainly the subject of implicit
definition since they were paid for by a global budget.
8.4.1.2 Health care policy-making and organisation
The French health care system is a very centralized model, with an important role for
the regions. Regions are responsible for the factual organization and execution of health
hh This paragraph is mainly based on the report “health systems in transition: France, WHO, 2004.